Relationship between the chest radiograph, regional lung function studies, exercise tolerance, and clinical condition in cystic fibrosis

This study evaluated the accuracy of the interpretation of the chest film in delineating localised abnormalities of ventilation and perfusion, as well as the overall severity of airways obstruction, exercise tolerance, and clinical condition in children with cystic fibrosis. Radiographic findings in various regions of the chest film were compared with the functional values obtained with regional lung function tests which evaluated the arrival and disappearance of boluses of radioactive nitrogen given by inhalation and infusion. While the more severely affected areas on the chest radiograph were found to correlate with similar regions on the lung function tests, as did overall scores, errors occurred in some cases if the x-ray film alone was used as a judge of regional physiological derangement. In addition the degree of airways obstruction, the exercise tolerance on a cycle ergometer, and clinical grading, each correlated significantly with the radiographic score. We conclude that the chest radiograph is a good indicator of the overall severity of the lung disease and that it correlates well with exercise tolerance and clinical condition in cystic fibrosis.     

Extended TIP(P) analogues as precursors for labeled delta-opioid receptor ligands

Tyr-Tic-Phe-Phe-OH (TIPP) and the shorter Tyr-Tic-Phe-OH (TIP) peptides are potent and highly selective antagonists at the delta-opioid receptor and, therefore, are ideal candidates for the attachment of labels to assist in the study of delta-opioid receptors. Peptides extended at the C-terminus with residues which can be used as handles for further modification and/or labeling (i.e. Asx, Glx, and Lys) were synthesized. The TIPP-D/L-Asx/Glx derivatives exhibited similar delta-receptor affinity to TIPP (K(i) = 5-10 nM vs K(i) = 6 nM), and neither the location of the carboxylic acid moiety nor the stereochemistry of the C-terminal residue significantly affected the delta-receptor affinity of these derivatives. Extension of TIPP with an additional residue did not increase mu-receptor affinity, even though the position of the acidic group, which imparts delta-receptor selectivity to TIPP, was shifted relative to the carboxylic acid moiety of TIPP. The delta-receptor affinities of the TIP-D/L-Asx/Glx derivatives were found to be influenced mainly by the position of the carboxylic acid function rather than the stereochemistry of the C-terminal residue. TIP(P)-D/L-Lys(Ac)-OH derivatives exhibited moderate delta-receptor affinity (K(i)(delta) = 16-28 nM). The most potent compounds found in the extended TIP(P) series were TIPP-D-Gln-OH and TIP-D-Gln-OH (K(i)(delta) = 5 nM) which had similar affinities to TIPP.     

Moving to a Continuing Care Retirement Community: Occupations in the Therapeutic Landscape Process

The process of transitioning into, and living in, a retirement community can be usefully examined with the concept of ‘therapeutic landscapes.’ While underutilized in anthropology and gerontology, the concept offers a combination of geographical and cultural views on the place and well-being relationship. The inclusion of an occupational science perspective, wherein occupations (or everyday activities of meaning) are seen as a crucial part of the person-place relationship, should enhance the therapeutic landscape perspective of older persons and their retirement communities. We present a case study analysis that attempts to combine these perspectives and examine the role of occupation in the lives of older people who moved to a Continuing Care Retirement Community (CCRC). 116 movers completed pre- and post-move questionnaires about their levels of engagement in 20 activities. Frequency distributions, paired t-tests, and logistic regression analyses performed on the data indicate that while overall levels of activity did not change from pre- to post-move, patterns of engagement did change in the course of the move to the CCRC. Some social and cultural activities (e.g., parties, concerts, movies, meetings) increased in frequency, and some maintenance chores (e.g., grocery shopping, housekeeping) and communication (email) decreased in frequency. Moreover, total activity engagement after the move was associated with residential satisfaction in the CCRC. Even with their limitations, the data and analytical findings suggest that occupations are an important part of the CCRC therapeutic landscape process.     

Localization of immunoreactive cholecystokinin precursor to amacrine cells and bipolar cells of the macaque monkey retina

We used antisera that recognized precursors of the neuropeptide cholecystokinin extended at the carboxyl terminus in an immunocytochemical study of the macaque retina. A subpopulation of bipolar cells with long, obliquely oriented dendrites was labeled. Their axons terminated exclusively in the fifth stratum of the inner plexiform layer, where they contacted processes of amacrine and ganglion cells. Based on their morphology, these cells appeared to be the type that contacts short-wavelength cones selectively. Two types of amacrine cells were also labeled, and processes from both types formed dense plexuses in the second and fourth strata of the inner plexiform layer. The majority of their synaptic connections were with other amacrine cells, but they had more contacts with bipolar cell axons and retinal ganglion cell dendrites than any other peptidergic cells in the macaque retina. We studied extracts of macaque retina with gel-filtration chromatography and radioimmunoassays to confirm our immunohistochemical results. We found cholecystokinin octapeptide and other immunoreactive forms that were amidated at their carboxyl termini and were therefore likely to be biologically active. Unlike most other regions of the CNS, however, the retina had relatively low concentrations of amidated forms, and forms with extended carboxyl termini that are presumably their precursors were far more abundant. These findings suggest that the rate of cholecystokinin synthesis in the retina is quite high, as we would expect if the peptide were found in tonically active neurons.     

CT patterns of intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction

Computed tomographic (CT) patterns of intracranial hemorrhage (ICH) were determined in 1,696 patients undergoing thrombolytic therapy for acute myocardial infarction. ICH occurred at 33 sites in 0.77% of patients (n = 13). Thirty-six percent of hemorrhages (n = 12) were intraparenchymal, 33% (n = 11) were subdural, 24% (n = 8) were subarachnoid, and 6% (n = 2) were intraventricular. Eight-four percent (n = 26) of all nonventricular hemorrhages were supratentorial in location. The most common site of ICH was supratentorial and intraparenchymal (10 of 33). In 11 of the 13 patients with ICH, clinical symptoms occurred within 24 hours of the initiation of thrombolytic therapy. A fatal outcome resulted in three of the four patients who had clinical symptoms within 3.5 hours after beginning thrombolytic therapy. The CT findings of multiple intracranial bleeding sites, substantial mass effect with midline shift, and large-volume intraparenchymal hematomas were associated with increased mortality. ICH associated with thrombolytic therapy for acute myocardial infarction has a grave prognosis, with 62% of patients dying during hospitalization.     

Clinical characteristics and outcome of current standard management of central retinal artery occlusion

Background: To investigate the visual outcomes in acute central retinal artery occlusion (CRAO) with current standard therapy at two university teaching hospitals. Methods: Retrospective analysis of two cohorts of CRAO patients from John Hopkins Hospital (JHH; USA), and Flinders Medical Centre (FMC; Australia), treated with current standard therapy. The outcome measures were visual acuity, and subsequent ocular and systemic ischaemic events. Results: The mean follow‐up period was 11.2 ± 13.1 months in the JHH cohort and 35.4 ± 34.9 months in the FMC cohort. The frequency distribution of vascular risk factors and the incidence of subsequent ischaemic events were similar for the patients from both institutions. All patients from JHH were treated as inpatients, whereas 79% of patients from FMC were treated as outpatients. More patients in the JHH cohort underwent paracentesis, ocular massage or were treated with intraocular hypotensive agents (76%) than in the FMC cohort (26%); however, there was no significant difference in visual outcome between the two cohorts (P = 0.114). Conclusion: Despite differences in management of CRAO between two institutions in different countries, visual outcomes were similar. This suggests a lack of efficacy of current standard treatment in acute CRAO.     

Are morning headaches part of obstructive sleep apnea syndrome?

To determine whether morning headaches are a consistent symptom in sleep apnea, we reviewed clinical and polysomnographic data of 304 patients with sleep apnea and compared the findings with normal control subjects and with three other groups of patients seen at a sleep disorders center. Eighteen percent of patients with sleep apnea had frequent morning headaches compared with 21% to 38% in the other groups of patients and 6% of control subjects. In patients with sleep apnea, morning headaches were most common in those with mild predominantly nonobstructive apnea. Polysomnographic characteristics of patients with moderate to severe sleep apnea did not significantly differ between patients with frequent headaches and those without such headaches. Frequent morning headaches are a nonspecific symptom in patients with sleep disorders and are not a consistent or reliable symptom of sleep apnea syndrome.     

Spondylometaphyseal dysplasia, corner fracture type: a heritable condition associated with coxa vara

The authors present the radiographic features of a previously incompletely delineated bone dysplasia, which they call spondylometaphyseal dysplasia, corner fracture type. This is a dominant heritable condition associated with short stature and developmental coxa vara. The progressive hip deformity usually causes significant disability requiring surgical correction. Developmental coxa vara, simulated corner fractures of long tubular bones, and vertebral body abnormalities result in a diagnostic constellation. Knowledge of these distinctive radiologic features allows accurate diagnosis, which in turn should lead to appropriate genetic counseling and possibly to earlier, more efficacious surgical treatment of the coxa vara.     

All-terrain vehicle injuries in central Wisconsin: a continuing problem

All-terrain vehicles (ATVs) have become well recognized as associated with injuries. This recognition has resulted in attempts at education and regulation to reduce the number and severity of injuries and number of deaths. The Marshfield Clinic and St. Joseph's Hospital surveyed all-terrain vehicle accidents in the Emergency Department in 1985 and again in 1988 and followed these patients for at least 1 year after the injury. Between the two dates, extensive educational and legislative activity had taken place. The actual number of all-terrain vehicle accidents had increased. The characteristics of victims who were involved in all-terrain vehicle accidents did not change. The actual number of accidents associated with three-wheeled ATVs did not appreciably decrease but the number of accidents associated with four-wheeled ATVs did increase. To date, it is not clear that legislative and educational activities are effective in reducing the number of ATV accidents or in changing the pattern of the accidents.